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“Cut down on sweets, especially between meals” is perhaps one of the least popular words of advice we dentists regularly give. We’re not trying to be killjoys, but the facts are undeniable: both the amount and frequency of sugar consumption contributes to tooth decay. Our concern isn’t the naturally occurring sugars in fruits, vegetables, grains or dairy products, but rather refined or “free” sugars added to foods to sweeten them.

The World Health Organization and the U.S. Food and Drug Administration both advise consuming no more than 50 grams (about ten teaspoons) of sugar a day. Unfortunately, our nation’s average per person is much higher: we annually consume around 140 pounds per capita of refined sugars like table sugar or high fructose corn syrup, more than three times the recommended amount. Soft drinks are the single largest source of these in our diets — Americans drink an average of 52 gallons every year.

The connection between sugar and tooth decay begins with bacteria that ferments sugar present in the mouth after eating. This creates high levels of acid, which causes the mineral content of tooth enamel to soften and erode (a process called demineralization) and makes the teeth more susceptible to decay. Saliva naturally neutralizes acid, but it takes about thirty minutes to bring the mouth’s pH to a normal level. Saliva can’t keep up if sugars are continually present from constant snacking or sipping on soft drinks for long periods.

You can reduce the sugar-decay connection with a few dietary changes: limit your intake of sugar-added foods and beverages to no more than recommended levels; consume sweets and soft drinks only at meal times; replace sugar-added foods with fresh fruits and vegetables and foods that inhibit the fermentation process (like cheese or black and green teas); and consider using mint or chewing gum products sweetened with xylitol, a natural alcohol-based sugar that inhibits bacterial growth.

Last but not least, practice good oral hygiene with daily brushing and flossing, along with regular office cleanings and checkups. These practices, along with limits on refined sugar in your diet, will go a long way toward keeping your teeth and mouth healthy and cavity-free.

While tooth decay and periodontal (gum) disease destroy more teeth than any other causes, both of these diseases are largely preventable with proper oral hygiene and dental treatment. It’s more than possible, then, to enjoy a lifetime of healthy, disease-free teeth.

But even with healthy teeth, the effects of aging will cause tooth wear over time. And although we can’t prevent the aging process from occurring altogether, there are steps we can take not to accelerate the process.

Most tissues, including bone and teeth, have a growth cycle in which older cells are broken down (known as catabolism), removed and replaced by newer cells (anabolism). As we develop during childhood, the growth phase exceeds breakdown; when we reach adulthood, the two phases come into equilibrium. But as we age, breakdown will gradually overtake growth. This aging effect results in, among other outcomes, tooth wear.

“Normal” wear appears to be greatest — and most visible — along the biting surfaces of the teeth. The forces generated when we bite or chew causes enamel to erode over time. Unfortunately, you can accelerate this process through bad oral habits: clenching or grinding teeth, often times at night while you sleep, as well as habitually chewing on hard objects like nails or pencils.

Normal forces generated when we bite or chew are actually beneficial for dental health — they help stimulate bone growth. But when they exceed their normal range as when we clench or grind our teeth, they can increase tooth wear and cause other problems such as diminished function or changes in appearance, such as a shortened facial height.

To slow the rate of wear, it’s important to modify any behaviors that may be contributing to it. In many cases an occlusal night guard worn while you sleep helps prevent teeth clenching. You may also need assistance with stress management, a major trigger for these kinds of habits, through biofeedback therapy or counseling.

If you’ve already encountered excessive wear, bonding techniques using colored composite resin, veneers or crowns that attach directly to the teeth can restore lost function and rejuvenate the appearance and color of your teeth. We can perform a “smile analysis” to determine if one of these techniques is right for you to help you regain a more youthful and attractive smile.

Fans of the primetime TV show The Middle were delighted to see that high school senior Sue, played by Eden Sher, finally got her braces off at the start of Season 6. But since this popular sitcom wouldn’t be complete without some slapstick comedy, this happy event is not without its trials and tribulations: The episode ends with Sue’s whole family diving into a dumpster in search of the teen’s lost retainer. Sue finds it in the garbage and immediately pops it in her mouth. But wait — it doesn’t fit, it’s not even hers!

If you think this scenario is far-fetched, guess again. OK, maybe the part about Sue not washing the retainer upon reclaiming it was just a gag (literally and figuratively), but lost retainers are all too common. Unfortunately, they’re also expensive to replace — so they need to be handled with care. What’s the best way to do that? Retainers should be brushed daily with a soft toothbrush and liquid soap (dish soap works well), and then placed immediately back in your mouth or into the case that came with the retainer. When you are eating a meal at a restaurant, do not wrap your retainer in a napkin and leave it on the table — this is a great way to lose it! Instead, take the case with you, and keep the retainer in it while you’re eating. When you get home, brush your teeth and then put the retainer back in your mouth.

If you do lose your retainer though, let us know right away. Retention is the last step of your orthodontic treatment, and it’s extremely important. You’ve worked hard to get a beautiful smile, and no one wants to see that effort wasted. Yet if you neglect to wear your retainer as instructed, your teeth are likely to shift out of position. Why does this happen?

As you’ve seen firsthand, teeth aren’t rigidly fixed in the jaw — they can be moved in response to light and continuous force. That’s what orthodontic appliances do: apply the right amount of force in a carefully controlled manner. But there are other forces at work on your teeth that can move them in less predictable ways. For example, normal biting and chewing can, over time, cause your teeth to shift position. To get teeth to stay where they’ve been moved orthodontically, new bone needs to form around them and anchor them where they are. That will happen over time, but only if they are held in place with a retainer. That’s why it is so important to wear yours as directed — and notify us immediately if it gets lost.

And if ever you do have to dig your retainer out of a dumpster… be sure to wash it before putting in in your mouth!

A critical part of effective, daily oral hygiene, flossing removes bacterial plaque from between teeth that can’t be accessed with brushing. Unfortunately, it’s often neglected — string flossing requires a bit more dexterity than brushing and can be difficult to do properly.

It can be even more difficult for people with implants or who wear orthodontic appliances. For brace wearers in particular, getting access to areas between teeth with string floss is next to impossible; the metal brackets and tension wire also have a tendency to catch and retain food debris that’s difficult to remove with brushing alone.

Water flossing, using a device called an oral irrigator, is an effective alternative that addresses many of these difficulties. First available for home use in the 1960s, an oral irrigator delivers pulsating water at high pressure through a handheld applicator that forcefully flushes material from between teeth.

There’s no question that string flossing is effective in plaque removal between teeth — but what about oral irrigators? A 2008 study looked at a group of orthodontic patients with braces who used oral irrigators and compared them with a similar group that only brushed. The study found that five times as much plaque was removed in the group using the oral irrigators as opposed to the group only brushing.

Oral irrigators may also be effective for people who’ve developed periodontal (gum) disease. In fact, oral irrigators coupled with ultra-sound devices are routinely used by dental hygienists to remove plaque and calculus (hardened plaque deposits) in periodontal patients. As with regular oral hygiene, though, it’s important for patients with gum disease to include water flossing with daily brushing (at least twice a day) and regular cleaning sessions at the dentist to ensure removal of all plaque and calculus.

If you’re interested in using an oral irrigator, be sure to consult with us at your next appointment. Not only can we recommend features to look for in equipment, but we can also instruct you on the techniques to make water flossing an effective plaque remover.

If your sleeping partner snores, it could be more than an annoyance: it could be a sign of sleep apnea. This occurs when air flow into the lungs becomes obstructed in the throat for a few seconds during sleep. The obstruction can take many forms, but a common one arises from the tongue relaxing against the back of the throat, producing snoring sounds as air attempts to pass through this restricted area.

Sleep apnea can cause severe problems: lower daily energy levels and mood from poor sleep; lower oxygen saturation that could affect brain function; and increased risk for cardiovascular disease. So, if you’re awakened by your partner’s snoring (or they’re complaining about yours!), it’s important to have it checked and treated.

This begins with a visit to us for a complete oral examination. Like many dentists, we’re well trained in the anatomy and structures of the mouth, as well as the causes and treatment of sleep apnea. We’ll examine your mouth, take into account any possible symptoms you’re experiencing and, if your suspicions are correct, refer you to a sleep physician to diagnose if you have sleep apnea.

Treatment will depend on its cause and severity. An oral appliance worn during sleep is the recommended first treatment for mild to moderate sleep apnea that involves the tongue as an obstruction. We develop a custom appliance that helps move your tongue away from the back of the throat, reducing both apnea and snoring sounds. For more advanced sleep apnea you could benefit from a Continuous Positive Airway Pressure (CPAP) machine. This device generates continuous air pressure through a mask worn while sleeping that helps keep the airway open.

Of course, there are other causes for obstruction, some of which may require surgical intervention to relieve the problem. Abnormally large tonsils, adenoids or excessive soft tissue can all restrict air flow. Surgically removing or altering these structures could help reduce airway restriction.

Whatever type or degree of sleep apnea you or your partner may have, there are solutions. The right treatment will not only improve overall health, it will help both of you get a better night’s sleep.

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